The 10-Second Rule: From a Leader Who Built Successful Commercial Teams at Medtronics, Advanced Bionics, Entellus and More

James Surek has spent the last couple of decades building successful commercial teams that increase the value of companies, which results in strong exits. He has done this at Medtronic Sofamor Danek, Advanced Bionics/Boston Scientific and Entellus Medical, as CCO of Stimwave, and is now taking on a new role as the CEO of the Medical Sales Nation.

James Surek CEO, Medical Sales Nation
James Surek, CEO, Medical Sales Nation

As VP Sales at Advanced Bionics/Boston Scientific, he oversaw sales growth from zero to $198M, with a 31% market share, in just three and a half years, resulting in a $489M acquisition by Sonova. Under his leadership as VP Sales and Development, Entellus achieved a 63% market share in a space formerly dominated by J&J, and was bought by Stryker for $664M. He is also co-founder of Medical Sales Nation, which offers medical sales professionals a community of peers and experts to interact with and learn from, using podcasts, interviews and other tools to communicate best practices and assist in collaboration.

He’s about to publish an ebook that details out the step by step process he’s used to build these sales forces. The book is free, and he has agreed to share some of what he’s learned about building a commercial team.

There are four key areas of focus he has determined are vital:

  1. Drilling down to the differentiation, which he facilitates in a unique way, challenging marketing and engineering to work together towards developing a targeted market value matrix
  2. Designing and building the right commercial team, taking into account speed of uptake, competition, and service
  3. Improving the training process to match the market demands, with strategies like the 10 second rule.
  4. Putting in place a continuous feedback and improvement system so that field learnings are incorporated in marketing messaging and sales training


James has developed a process of going deep with marketing and engineering first towards the creation of a market value matrix.

It begins with interviewing marketing on how they perceive the landscape—clinical, financial, strategic, competitive—and looking at who benefits and how: the patients, physicians, practice and facility.

He then goes to engineering and engages the same process.

Do engineering and marketing agree? If so, great. If not, they need to listen to each other and come to an understanding of how to proceed. Sales leadership is present in these meetings not as a mediator but as a student trying to learn from two great teachers with possibly different perspectives who bring the meaning together.

He shared an experience he had with engineers at Advanced Bionics. The engineers were confident that they knew what made the product attractive, but were not convinced that the sales organization would have the understanding to sell it. What they explained were a lot of features. For instance, the product had four independent channels that could stimulate four areas of the body—knee, foot, etc.—simultaneously and independently. No other product could do that!

“Engineering is very passionate about the performance of a product which is good,” says James. “But their view of it doesn’t always translate into a benefit a doctor can understand.” If a patient has back, knee and foot pain on the right side, and knee pain on the left, all four areas could be treated at once. But what is the desired outcome? After a detailed conversation, he was able to determine that the four independent channels made treatment more comfortable, tolerable, accurate and defined. That, he knew, was something that would make physicians sit up and listen.

Then the strategy was to translate the benefits so they expressed a clinical, strategic and financial value. There must be a benefit to the physician, the patient, the practice and the facility.

“The value propositions for physicians, patients, practice and facility, refined by this feedback, form a kind of matrix that informs everything we do from that point forward. What is the doctor interested in? What is the pushback from the office manager? What is the evaluation of your technology? Where is your clinical evidence? What does your product portfolio look like? What is your financial impact on customers?”

Not everything on the market is a disruptive technology. “But you need to understand and explain how differentiated your product is in order to make it stand out in the mind of healthcare professionals,” says James. “There is no point in trying to sell a commodity product, unless you have a price advantage, and only the largest companies can compete on that basis.” In the early part of his career, before he joined Medtronic Sofamor Danek, he did a lot of homework because he had offers from several of the larger companies. People told him it was a tough area—there were a lot of litigation problems with spinal implants and pedical screws. But he also saw that other products—like hip and knee replacements and scopes—were largely commodity sales which would require years of relationship building to excel, and that Sofamor Danek had an opportunity to stand out in a marketplace where uniqueness would be valued. “If there is no uniqueness,” he says, “you have no clinical value.”

a table of value define

“You need to understand and explain how differentiated your product is in order to make it stand out in the mind of healthcare professionals”

But how do you assess the wisdom of that positioning? Here’s where we get to the market analysis part of the process.


There are three major factors that influence his approach to building the commercial team: the speed of uptake, the competition, and service requirements.

James points out, “With a $25,000 product, like the one we had at Advanced Bionics, you can develop your market slower. With crisp messaging and a new cutting-edge technology, we were able to build a team without medical experience. They came from B2B backgrounds—FedEx or Pitney Bowes—and had strong selling techniques and could apply their hunger and passion.”

At Entellus, “With a $1500 product, we had to sell a lot of them to hit our revenue number. Entellus had to build an office-based ENT market, it was not just about converting OR business. We had to build a brand new market. Plus we had significant competition from J&J and needed to bring in skilled reps with market knowledge and tap their more in-depth knowledge, to hit the ground running.”

At the beginning of any sales strategy, James says a lot of field feedback is required. That’s why he often hires regional managers first and has them do the legwork in specific territories. What they learn from this is a kind of beta test that will inform three things: the needs and beliefs of the customers (with respect to things like their image of the competition);

the type of messaging that will make your product seem unique and valuable; and the kind of sales team you have to build to deliver the marketing message. “Mike Tyson said all his opponents had plans…until they got punched in the face. We needed to absorb some of those punches to evaluate our strengths and weaknesses,” James says. “You have to know what the objections are going to be so you can do objection handling. You have to know what the saturation of competitors in the marketplace is.” You also have to deal with the realities of the company. If it can only afford to pay reps X dollars, then that will also influence who you can hire.


“Training is foundation of success,” says James. This covers a lot of territory. He has taught companies to create real-life scenarios so the sales force learns how to do role playing and objection handling across the spectrum, from the receptionist to the office manager to the physician. “You need to have an authentic conversation about your products and how they benefit the patient practice, patient, physician and facility. It’s like fighter pilot in-flight simulations.”

“Training is the foundation of success… You need to have an authentic conversation about your products.”

He has also built simulations of ORs with cadavers, so reps experience what the doctors do in a hospital setting. “In the end, we put them through an even tougher boot camp than anything they will deal with in the field. That prepares them for anything that comes up.” Asked for an example, he said “Let’s say the product is purple. Well, why is it purple? So you can see it better. What’s the result of that? If you can differentiate it from the tissue or vessel, this will cause surgical errors to go down by 20%. Success rates increase. Now you’re talking language the doctor can get excited about.”

He’s also become a proponent of memorization, which he resisted at first. “But I learned that memorizing the key messages gives you a library of solid answers to any objection that comes up. It’s said that in a stressful environment, you lose about 10 IQ points. Your skill sets diminish. Memorization helps you relax and stay on top of your game. Over time the sale reps put the memorization in their own words, but at training it needed to be exact.”

The market value matrix also covers such things as objection handling. If you know in advance any situation you’ll run into, you’ll be ready to answer all questions without hesitation. What are the ASC or hospital objections? We know that no product is perfect, so we need to be able to respond to a multi-headed customer and deal with every possible concern.

“At Advanced Bionics, the proof of the process was that we started out as the underdog, but—even with a B2B sales force not well-acquainted with medical devices—we captured one third of the marketplace in just three years.”

His ultimate measure is the 10-second rule: The proof in the message. He saw that the rep has to be able to express clearly and concisely the value message to every relevant party—physician, patient, practice, facility—in what might be called the 10-Second Rule. “If you can’t capture the essence in one brief statement or question to raise the conversation to an engaging level to think about things differently, you haven’t positioned yourself properly in a competitive marketplace,” says James.


“Once you’re ready to go out with your primary messaging, once your sales team is trained and disciplined, there’s still a lot of learning ahead,” he says. “There will always be new competition, new objections, new developments. So we are always on a listening tour. We solicit and incorporate feedback from all our sales personnel, and re-evaluate what we’re saying in response.”

This keeps you in a continual state of improvement, so you’re always ahead competitively and with respect to your messaging.

“In five years we owned 63% of marketplace, overcoming the dominance of Johnson & Johnson.”

At Entellus, James had the challenge of introducing a product that not only changed the instrument doctors were using, but the site of service and the anaesthesia technique as well. Doctors had to be willing to work with an awake patient, in the office, with a new tool. The clinical benefits to patient were phenomenal, but they found out that they had totally underestimated what was going to be needed for surgeon training.

They were surprised at the issue, and so created cadaver labs, and started to engage with surgeons at a higher level. They were taking the time and teaching sales how to make the product and procedure more accessible for the doctors . Then they did summits based on feedback from the field and let doctors teach doctors about everything they were learning to do office based procedures.

They also found out that they had a technology issue. They didn’t have a light at the end of the balloon for the sinuses. The engineering team had to respond to that need very quickly. “That is engagement,” says James. “Bringing it forward. Listening rather than being defensive and understanding the market demand.

”It took a little time, but in five years we owned 63% of marketplace, overcoming the dominance of Johnson & Johnson in that sector. We tripled the national sales in the first two years, exceeding targets, doubled sales in the third year, and increased sales by over 80% in year four, exceeding the forecast. We disrupted the market because the messaging was on point and created value for the ENT healthcare market place.”


At Medical Sales Nation, James is building on the belief of creating a learning environment for anyone who wants to engage, share and learn. The team at Medical Sales Nation is helping companies build, turn around and re-brand a sales and commercial organization that incorporates the strategies that are built on the methods and processes that he has used over the last 25 years.

All that is impressive, but it needs the support of everything he has learned in his career. Following James Surek’s advice, we can see that what he advises is always in a state of process. Learning about the marketplace. Learning about the beliefs and needs of customers. Learning about the competition. Understanding what kind of sales force you need. Understanding what kind of training they need. Understanding how to deliver the message concisely. And, finally, getting the feedback that will allow you to apply those lessons to continual improvement of everything you do.

What it adds up to is a seamless interaction and cooperation of all parties, contributing to satisfying the goals of everyone involved, from the engineers who create the product to the team enjoined to sell it, to the healthcare professionals who use it and the patients who benefit from it. Here’s how James says it: “Put your egos aside. Learn from your mistakes. Accept the reality of the marketplace and the customers. Design your product and your messaging to address differentiation for the physician, patient, practice and facility. Once you’ve engaged all those elements, you’re on your way to success.”

Engaging the sales organization with marketing and engineering to get agreement is always a process, not an event. Engineers and marketers think sales people should be more effective sooner than James thinks is reasonable.—“We need the support of everyone. We have to build the team to read from the same page and understand the others’ concerns. This means not taking anything personally, putting your ego aside, admitting when you’ve screwed up. That allows you to make changes quickly and efficiently in response to the market.

“You’re building a learning organization. Everyone is open to learning from each other. And that helps you build the fastest response system.”